Saturday, December 1, 2012

The fallacy of the “‘Hitler card’ fallacy”

"One person with a hereditary disease costs the government 5.50 reichsmarks daily. RM 5.50 a day can support a whole genetically healthy family!"
“Death pathway”.  What an amazingly sterile, bureaucratic way to describe starving and dehydrating your loved one to death.

I had planned to write a third post tying up the loose ends in my previous two posts about the roles of science and philosophy in the “God debate”.  And I may yet write a reflection for tomorrow, the First Sunday of Advent.  But this story in the London Daily Mail’s MailOnline has left me sick with disbelief and disgust:  As part of an ongoing independent investigation into the so-called Liverpool Care Pathway, the ministers of Britain’s National Health System are learning that young people and newborns are also being “placed on the death pathway”.  Part of the “death pathway” is the stoppage not only of certain medications but also of food and fluids. 

NHS is investigating whether cash payments to hospitals for meeting “death pathway targets” influenced doctors’ decisions.  I don’t know if it’s occurred to them that  setting targets was bad enough, never mind creating a monetary incentive to meet them. 

But even when a prognosis of “no hope of recovery” is — you’ll pardon the phrase — a dead certainty, starvation and dehydration multiply the suffering.  Bernadette Lloyd, a hospice pediatric nurse, recounts: “I witnessed a 14 year-old boy with cancer die with his tongue stuck to the roof of his mouth when doctors refused to give him liquids by tube.  His death was agonizing for him, and for us nurses to watch.  This is euthanasia by the back door.”

Lloyd is too kind.  I’d call it medical murder.

In a related story in the “doctors’ bible”, the good gray BMJ (British Medical Journal), an anonymous doctor writes about having witnessed the deaths of ten children who had been placed on the “death pathway”.  Describing a typical phone call with the parents of a newborn child with multiple congenital defects, “Doctor X” writes:

I have a growing sense of dread as I listen.  The parents want “nothing done” because they feel that these anomalies are not consistent with a basic human experience [?].  I know that once decisions are made, life support will be withdrawn. …
Like other parents in this predicament, they are now plagued with a terrible type of wishful thinking that they could never have imagined.  They wish for their child to die quickly once the feeding and fluids are stopped.  They wish for pneumonia.  They wish for no suffering.  They wish for no visible changes to their precious baby. 
Their wishes, however, are not consistent with my experience.  Survival is often much longer than most physicians think; reflecting on my previous patients, the median time from withdrawal of hydration to death was ten days.

Having watched my own brother die by inches, I know something of the pity and the helplessness that comes from watching someone you love suffer — the temptation is always there to say, “to suffer unnecessarily”.  The parents in Dr. X’s story are daunted by a list of procedures and therapies that may not insure their child’s survival past his first birthday, and unconsciously compare it to an idealized babyhood in which the greatest pain imaginable is a bit of colic. 

Where is the line between objectivity and despair?  Because the fact remains that suffering is a “basic human experience”; the only way to avoid suffering altogether is to not be conceived.  We can debate whether the pain I undergo is sufficient cause for me to take my own life;[1] my pain, however, is no sufficient warrant for you to take my life.  You may suffer to watch me suffer; as grounds for “mercy killing”, though, that’s horribly selfish.

As I tried to explain in “Some thoughts on Godwin’s Law”, the problem with the so-called “‘Hitler card’ fallacy” (“argumentum ad Hitlerum”) is the presupposition that the person who plays the Nazi card is arguing from the evil of the Nazi Party: “P is evil because the Nazis did it.”  In fact, the people who play the Nazi card are usually arguing that the intrinsic evil of p is/was the reason we called the Nazis “evil”; if p isn’t intrinsically evil, then it can’t serve as a basis for such a judgment against them.

Morally, there’s no real difference between “a life not worth living” and lebensunwertes Leben, “life unworthy of life”; or, if there is a difference, the frontier between the two is microscopically thin and easily crossed.  To say, “The Nazis’ motives were bigoted; ours are compassionate,” is to place the moral quality of an act on an entirely subjective basis — how the actor feels about the act or the subject of the act.  But if that’s the case, then any basis for calling the Nazis’ motives “evil” is negated because subjective; you can’t even call bigotry “evil” because someone somewhere feels good about it.

The fact is, beneath both the bigotry and the compassion is the condescending conviction that a disabled person’s ability to lead a full, rich life is directly correlated to his physical or mental capacity: a paraplegic has a low quality of life because she can’t do jumping jacks or go rock-climbing, and a man with Down’s syndrome suffers because he’ll never become an accountant or a theoretical physicist.  This Pecksniffian pseudo-concern for the disabled’s quality of life is a perfect carpet under which we can sweep less noble motives (financial concerns, careers, eugenic perfection, etc.).

But the mistaken idea that suffering is sufficient cause for taking life is only part of the problem.  As Lloyd testifies, “The parents feel coerced, at a very traumatic time, into agreeing that [the death pathway] is correct for their child whom they are told by doctors has only has a few days to live.  It is very difficult to predict death.  I have seen a reasonable number of children recover after being taken off the pathway.” 

Just because the doctor has given up hope — or foresworn it as a “professional liability” — doesn’t always and necessarily mean the case is hopeless.  Very recently we learned that people with severe brain injuries or in “persistent vegetative states” do have some awareness of the outside world, lay down new memories and can answer “yes/no” questions with current technology.  I’m sure somewhere Terri Schiavo is smiling ironically.

“But if they’re going to die anyway ——”

We’re all going to die anyway.  That gives us no excuse to hurry anyone along the path to our common destiny.  The role of the doctor is not to take life but to preserve it.  If this he can’t do, then as Hippocrates said, at least he should do no harm.[2]

One final note: I’ve been writing this without the Affordable Care Act in mind.  I don’t need to indulge in “Obama hate” to see the drive towards euthanasia in the US — we’re already seeing it rise on the state level.  In that spirit, I’d like to leave the last word to Christopher Johnson of Midwest Conservative Journal:

If all this doesn’t bother you, if, after reading this story, you still support pulling the plug anyway, you better start coming up with euphemisms.   You need to quickly invent catchphrases and terminology for the leftist media to relentlessly pound home in order for you to convince yourself that you’re still a decent and moral person and not a trigger man for some progressive einsatzgruppe.
But most important of all, you need to be prepared to explain why killing Terri Schiavo and others like her is different than the Nazis euthanizing physically or mentally handicapped Germans.   Because you know perfectly well that people like me are going to continue to bring up that historical comparison. 

[1] In fact, I reject suicide as a moral option.  Deliberately choosing a course of action that would lead to my death in order to save or defend others is not, however, equivalent to suicide.
[2] Of the Epidemics 1:2:5.